Real Property Income And Expense (Rpie) Statement Form

REAL PROPERTY INCOME AND EXPENSE (RPIE) STATEMENT 2011

APPLICATION FOR WAIVER FROM ELECTRONIC FILING OF RPIE AND

Finance

REQUEST TO FILE A PAPER RPIE STATEMENT

FILING DEADLINE: AUGUST 6, 2012

Mail Waiver Application to: NYC Department of Finance, Legal Affairs-RPIE, 345 Adams Street, 3

Floor, Brooklyn, New York 11201

Instructions - This application is a request for waiver of the electronic filing requirement and to allow for the completion of the

the paper format of Form RPIE-2011 (RPIE-2011-A) pursuant to §11-208.1 of the Administrative Code of the City of New York.

Who may file this application - You may complete this application if:

(i) you are required to file Form RPIE-2011; and

(ii) you are a senior citizen or have a disability; and

(iii) you are the owner of the property(ies) and cannot file Form RPIE-2011 electronically.

This application may be used only if you are filing for 9 (nine) or fewer properties. All other filers must file electronically.

You must submit this application by August 6, 2012.

PART I: OWNER AND PROPERTY INFORMATION

SECTION A - OWNER INFORMATION

1. Please check all that apply if you are the owner of the property(ies) and you are filing for 9 (nine) or fewer properties:

I have a disability and it is difficult for me to complete the RPIE electronically.

I am a senior citizen and it is difficult for me to complete the RPIE electronically.

2a. Ownerʼs Name: _____________________________________________________________________________________________

b. Ownerʼs Employer Identification Number:

c. Ownerʼs Social Security Number:

d. Additional Ownerʼs Name: _____________________________________________________________________________________

e. Additional Ownerʼs Employer Identification Number:

f. Additional Ownerʼs Social Security Number:

g. Additional Ownerʼs Name: _____________________________________________________________________________________

h. Additional Ownerʼs Employer Identification Number:

i. Additional Ownerʼs Social Security Number:

SECTION B - CONTACT INFORMATION

1. Contact Name:______________________________________

2. Firm Name: ___________________________________________

3. Contact Address: ____________________________________

(

)

ADDRESS WHERE WAIVER REQUEST DETERMINATION IS TO BE MAILED

4. Telephone #: ______________________________________

5. E-mail Address (if any): _________________________________

6. Address of Property: ________________________________

7. Borough: ________________________________

b. Block:

__________________________

c. Lot: ___________________

8. Individual condominium unit owners filing for 9 (nine) or fewer lots, please indicate if this filing covers:

Condominium lot range from lot ______________ to lot ______________

All lots within a range from lot ______________ to lot ______________;

from lot ______________

to lot ______________

from lot ______________ to lot ______________;

from lot ______________

to lot ______________

from lot ______________ to lot ______________;

from lot ______________

to lot ______________

RPIE-2011-WAIVER REQ 06.07.12

Real Property Income And Expense (Rpie) Statement Form - 2011

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